CO-198 — Authorization exceeded
Claim-adjustment reason code 198 · typically reported as CO-198
What it means
There IS an authorization, but the claim goes beyond it — more units, longer span, or a different code than approved.
Why DME claims hit it
- Rental months billed past the authorized span
- Quantity above the approved units
- Upgraded item delivered vs. the code authorized
How to fix it
- Reconcile claim lines against the auth letter; request an extension/revision BEFORE the next cycle; rebill within authorized scope
Appeal posture
Appeal with clinical justification if the extra units were medically necessary and the plan allows retro modification.
Related denial codes
CO-197 — Prior authorization absentCO-15 — Authorization number missing or invalidCO-119 — Benefit maximum reached
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